One day, Doug Johnson plans to write a book about opening a hospital. He'll have plenty to write about.
Presbyterian Healthcare Services' newest facility, Rust Medical Center, Rio Rancho, N.M.-a 92-bed, full-service hospital-opened Oct. 23, and Johnson played an integral role in the facility's planning and development as its clinical project manager.
In the past year, Johnson helped design and implement several leading-edge approaches at Rust Medical Center, including acuity-adaptable rooms that have reduced patient transfers and an electronic ICU that combines telemedicine, software, and 24/7 monitoring technology.
To help identify and test these novel approaches, Johnson developed an innovation lab-of which he is now director.
In a recent interview, Johnson discussed what the innovation lab does and offered advice to health system leaders on inspiring and implementing breakthrough improvements.
How was Rust Medical Center's first week in operation? Is there anything you would do differently?
Doug Johnson: Very emotional and exciting, yet stressful. We tried a soft opening: surgery on the first day, labor and delivery on the second day, and the emergency department on the third day. This was an effective approach to ease into care and allow staff to be comfortable.
The amount of volumes we had was more than we anticipated. For example, in our labor and delivery area, we had a lot of babies born the first week. Our first baby born was a Cesarean section, so we broke that area in real fast. We also anticipated having an average daily census in our six-bed ICU of two patients, and we quickly went to four.
In hindsight, there's probably a million things I'd do differently. Before we opened up, we did mock runs using a lot of our leaders as patients. I would have spent a little bit more time on these simulations with more resources, ensuring the processes we built were running as smoothly as we had hoped they would.
Can you explain what your hospital's innovation lab does?
Johnson: The innovation lab is a space within our facility that is set up for testing and trying new ideas and innovations that will be implemented across the health system.
I have six full-time employees who lead and create innovation projects. It's too soon to talk about the ideas we're working on now, but these won't be things like reducing the ED's left-without-being-seen rate from 3 percent to 2 percent. That's very specific, and the improvement is relatively small. We're looking for disruptive innovation, something that's huge-40 percent to 50 percent improvement.
The innovation lab has mobile walls so we can create spaces for brainstorming meetings and observation areas. In the observation areas, we can mock up patient rooms and design concepts that can be monitored. Everything in the lab is on wheels, so it can be moved and configured in any way quickly.
How is process improvement different from innovation?
Johnson: Process improvement is looking at what you already know how to do, and trying to make those processes better. For example, when our length of stay is too long and we want to reduce it, we identify the steps or tasks that are adding to our excess length of stay and we try to make those steps more efficient.
With innovation, we're trying to come up with completely different ways of doing things. We are not necessarily looking for the financial impact, although that's important. Our focus is on the customer experience. We want to create a great, healthy experience for patients.
Can you provide examples of your innovation approach?
Johnson: We spent a lot of time in our other facilities videotaping and conducting a work analysis on our nurses to see what they spend their time on. We found that between 30 percent and 40 percent of the time nurses are traveling, they're walking.
So we decentralized our nursing stations. For a 24-bed unit, we have 12 decentralized nursing stations. We have four medication rooms, which means that every six beds has one automated medication dispensing cabinet. We also decentralized to much smaller supply rooms, equipment rooms, and utility rooms. By decentralizing our nursing stations, we reduced the number of miles each of our nurses travels a year by about 150 miles. That's huge.
Another example is our acuity-adaptable rooms. We've made it so patients will never have to leave their rooms during their stays unless they require ICU-level care. Each room can be adjusted to match a patient's acuity, including the addition or removal of medical equipment. We also bring much of the care to the patient; for example, dialysis and gastrointestinal procedures are done at the bedside.
The patient rooms are separated into two sections. One is the worker area, where there is a sink for caregivers to wash their hands, a table where nurses or physicians can work on their charts, and a computer for the nurse to record vital data without disturbing the patient. The other side is our family zone, which has a sleeper sofa, a workstation for family members, and a wardrobe. We don't have visiting hours. We think family members are just as important in a patient's healing and caregiving as we are, so we want them here.
We also put patient lifts in every patient room to prevent back injuries for caregivers and to provide for the dignity of the patient. Instead of four or five people moving a patient from the bed to a chair, one person can do that using a patient lift.
Can you share one important lesson learned about creating a foundation of innovation?
Johnson: Culture is everything. Innovation is a word, but it happens through people.
We have intentionally designed our culture around our mission statement: "We are healthcare professionals who partner with our customers to create an exceptional healthcare experience through innovation."
To help our staff embrace our mission, we identified the competencies that we felt were important:
Then we pulled our employees together and asked them to help define these competencies. For example, for service orientation, we asked employees: What service principles do you feel are most important? How are you going to design what you do? How are you going to create the behavior standards around the culture that we are trying to create?
These 40 frontline employees who helped design the culture came up with these service principles:
Do you have any advice that you would give healthcare leaders who may be undertaking a major project, such as opening a hospital?
Johnson: I use one phrase a lot: "Just be a real human being." When we first started designing this hospital, staff would ask questions like, "How are we going to do this?" or "How did we mess this up?" I'd look across the room of and say, "OK, anyone in this room who has ever built a hospital before, please raise your hand," and there wasn't a single hand that went up.
We absolutely have to be humble about how we go about things. I don't think that sharing with employees your humility as a leader is a bad thing. I think sharing your weaknesses, empowering your staff to strengthen you, and taking advice from them are probably the most important things that you can do.
Interviewed for this article:
Doug Johnson is clinical project manager, Rust Medical Center, Rio Rancho, N.M., and director of innovation, Presbyterian Healthcare Services, Albuquerque, N.M. (firstname.lastname@example.org).
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